HAMILTON, ONT. – A ground-breaking project is underway at Hamilton Health Sciences (HHS) to address a major medical shortcoming in Canada and around the world: too many patients develop complications after having cardiac and vascular surgery, and many are re-admitted to hospital after they’re discharged home.
The SMArTVIEW remote-monitoring project – which has attracted over $12 million in government and industry support – uses Philips wireless electronic devices to monitor patients’ vital signs following surgery and alert healthcare providers of any indications that the patient’s condition may be declining. The system also enables hospital-to-home virtual recovery support.
The project aims to monitor up to 600 patients at HHS and in Liverpool, UK, at the Liverpool Heart and Chest Hospital. The system is unique in that it will monitor post-op cardiac and vascular patients, after they are transferred to step-down units or surgical wards in the hospitals, as well as at home, once they are discharged.
SMArTVIEW will continuously monitor the post-op patients in hospital, 24/7, using a variety of wireless electronic devices, to ensure their vital signs are stable. If not, alerts will be generated and sent to nurses, who can attend to the patients or escalate by contacting physicians or rapid-response teams.
Once they are discharged from hospital, usually after five or six days, patients will continue to be monitored, once a day, by nurses using two-way video on tablet computers, and by devices capable of measuring vital signs, weight, and other metrics.
“There’s a real problem,” said Ted Scott, chief innovation officer at HHS. “After heart or vascular surgery, there’s a 6 percent to 8 percent rate of complications, and North American data show that up to 18 percent of patients can be re-admitted.”
As well, about 40 percent of these post-op patients experience unrelieved pain for up to three months. These are poor outcomes for patients, and they can lead to huge costs for hospitals.
Scott compared the high rates of post-op complications with the low rates of problems encountered inside the OR. “Complication rates in the operating room are lower because patients are being closely monitored,” he said.
The idea of SMArTVIEW is to raise the level of monitoring once patients have left the OR through the use of wireless, electronic equipment.
To accomplish the task, a team at HHS worked for the past two years on the design of the system and gained buy-in from clinicians. Through open procurement, the team also assembled a group of vendors who created unique solutions for in-hospital and remote, at-home monitoring.
The key vendors include Philips and ThoughtWire, which are contributing hardware and software for vital signs monitoring; QoC of Toronto, which has produced an interface that promotes patient self-care; and XAHIVE, which is consulting on cybersecurity.
The inpatient monitoring software solution, known as Philips IntelliVue Guardian, is designed to detect patient deterioration, send clinician validated vital signs from the vital sign monitoring devices to the EMR at the point of care, and to automatically alert clinicians if there is a change in patient status.
ThoughtWire’s intelligent platform is being used to automatically relay the alerts to the appropriate clinicians and teams.
The inpatient hardware consists of the vital sign monitors and wireless measurement devices. The outpatient monitoring solution will use the Philips eTRAC solution. The eTrAC ambulatory telehealth program enables clinicians and patients to stay closely connected during the transition to ambulatory care for chronic disease management.
Recently, the SMArTVIEW development team has been fine-tuning the alerts and workflows that are a key part of the system. Dr. Michael McGillion, assistant dean of research at the school of nursing, McMaster University and SMArTVIEW project lead investigator, explained that nurses have been involved in the testing of the solution at Hamilton Health Sciences and the Liverpool Heart and Chest Hospital.
They have been involved in high-fidelity simulations where trained actors play the role of patients, while they learn to use the technology, on the hospital ward.
“They then debrief with us on the experience and this allows us to optimize the configuration of our systems, as well as the workflow,” commented McGillion.
During the actual SMArTVIEW trial, which will start in the fall, McGillion noted that it is expected that over 80 nurses will be involved from both countries, along with surgeons and clinical staff.
While other vendors and healthcare systems in Canada have launched remote monitoring projects, Scott believes SMArTVIEW differs in its combination of in-hospital and at-home monitoring. He explained that most post-op patients are not closely monitored for the five to six days they are recuperating from surgery in the hospital.
In contrast, SMArTVIEW will provide comprehensive electronic monitoring in step-down units and surgical wards. Once the patient returns home, the monitoring will continue with daily, virtual visits by a nurse, who the patient will see on his or her Samsung tablet computer.
The patient will be able to discuss his condition, transfer vital signs, and also send photos of wounds.
In all, the patients will be monitored for a total of 30 days. “After 30 days, most of the danger is over,” said Scott.
He pointed out that patients recovering at home will be monitored by a trained surgical nurse, based in the hospital, who is familiar with surgical issues and potential problems. In contrast, most patients convalescing at home are traditionally visited by home care nurses who are not necessarily trained to deal with post-op pain, wound care and other complications.
The SMArTVIEW project has partnered with the Liverpool Heart and Chest Hospital, in the UK, as it is a centre that specializes in cardiac and vascular surgeries and sees a high volume of patients. It is also associated with Coventry University, where researchers have devised tools for support patient self-management during recovery. This expertise is being incorporated into the SMArTVIEW software.
“It was a natural fit to work with them,” said Scott.
Overall, the home monitoring system will track many data-points. It will give clinicians a clear idea of the patients who are at greatest risk of developing complications, such as infections.
“We can then increase the monitoring or make the appropriate intervention,” said Scott.
Patients will be trained in self-care, too, so they can take better care of themselves and improve outcomes. The SMArTVIEW system includes an easy-to-use interface on that tablet for self-care, including goals for the patient.
Social media is another component of the project; it will enable patients to chat with each other and learn from their shared experiences. “We believe there is an important role for peer-to-peer learning,” said Scott.